有冲动行为注意缺陷多动障碍儿童脑功能性磁共振的研究

李飞; 李宝娟; 苏林雁; 胡德文; 刘军; 贺忠; 周顺科

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中国当代儿科杂志 ›› 2010, Vol. 12 ›› Issue (1) : 24-28.

论著·临床研究

有冲动行为注意缺陷多动障碍儿童脑功能性磁共振的研究

李飞，李宝娟，苏林雁，胡德文，刘军，贺忠，周顺科

作者信息 +

A functional MRI study in ADHD children with impulsivity

LI Fei, LI Bao-Juan, SU Lin-Yan, HU De-Wen, LIU Jun, HE Zhong, ZHOU Shun-Ke

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摘要

目的：冲动是注意缺陷多动障碍(ADHD)儿童的核心症状。为了解ADHD患儿冲动行为的神经机制，该研究利用功能性磁共振成像技术调查了有冲动行为ADHD儿童的脑功能影像特点。方法：以GO/STOP冲动行为测量软件中的GO及STOP为任务，对自愿参加的10例有冲动行为ADHD、7例无冲动行为ADHD及9例正常男童进行脑功能成像。然后将3组儿童的脑功能像分别合并平均，得出3组在执行两个任务时的平均脑功能像，最后比较3组平均脑激活区的分布情况。结果：执行GO任务时，正常儿童的激活区域主要是额极（额上回、额中回、额内侧回）；无冲动ADHD患儿是小脑（后叶、前叶小结）、扣带回；冲动ADHD患儿是内侧苍白球、岛叶。执行STOP任务时，正常儿童的激活区域主要为额上回等区域；无冲动ADHD患儿为额中回、胼胝体；冲动ADHD患儿为钩回、扣带回。冲动ADHD儿童的激活的脑区远较其他两组少。结论：参与控制冲动的大脑皮层分布广泛，与正常儿童相比，无冲动行为ADHD患儿脑功能明显不足，激活的脑区少；有冲动行为ADHD患儿激活的脑区更少，脑功能表现更差，皮层唤醒不足。［中国当代儿科杂志，2010，12（1）：24-28］

Abstract

OBJECTIVE: Impulsivity is one of the core symptoms of children with attention deficit hyperactivity disorder (ADHD). In order to understand the neuromechanism of the impulsive behaviors in ADHD children, this study investigated the specific functional areas of the brain by functional MRI. METHODS: The subjects consisted of 10 ADHD children with impulsivity, 7 ADHD children without impulsivity and 9 normal children. A functional MRI examination was performed when the subjects were instructed to finish GO and STOP tasks with the GO-STOP impulsivity paradigm. The MRI data during the two tasks of GO and STOP were averaged and the corresponding activation regions between groups were compared. RESULTS: The data from the GO task revealed that the main activation regions of the normal children included frontal pole (superior frontal gyrus, middle frontal gyrus and medial frontal gyrus); the main activation regions of ADHD children without impulsivity were cerebellum (posterior lobe and anterior lobe bouton) and cingulated gyrus; those of ADHD children with impulsivity were medial globus pallidus and insula. The data from the STOP task showed that the main activation regions of normal children included superior frontal gyrus and middle frontal gyrus; those of ADHD children without impulsivity were middle frontal gyrus and cingulate gyrus; those of ADHD children with impulsivity were uncus and putamen. The activation regions of ADHD children with impulsivity were much fewer than the other two groups. CONCLUSIONS: The behavior of impulsivity-control involves a number of specific functional areas in the cerebral cortex. Compared with normal children, ADHD children without impulsivity have weaker brain function and brain activation, and ADHD children with impulsivity demonstrate much fewer brain activation regions, worse brain function and little awareness of the cerebral cortex.［Chin J Contemp Pediatr, 2010, 12 (1):24-28］

导出引用

李飞, 李宝娟, 苏林雁, 胡德文, 刘军, 贺忠, 周顺科. 有冲动行为注意缺陷多动障碍儿童脑功能性磁共振的研究[J]. 中国当代儿科杂志. 2010, 12(1): 24-28

LI Fei, LI Bao-Juan, SU Lin-Yan, HU De-Wen, LIU Jun, HE Zhong, ZHOU Shun-Ke. A functional MRI study in ADHD children with impulsivity[J]. Chinese Journal of Contemporary Pediatrics. 2010, 12(1): 24-28

中图分类号： R749.94

参考文献

［1］石统昆, 武丽杰, 王风华, 孙彩虹，周莓，陈素芬. 不同亚型注意缺陷多动障碍儿童视觉工作记忆研究［J］. 中国妇幼保健, 2008, 23(15):2082-2084.
［2］Rubia K, Halari R, Christakou A, Taylor E. Impulsiveness as a timing disturbance: neurocognitive abnormalities in attention-deficit hyperactivity disorder during temporal processes and normalization with methylphenidate［J］. Philos Trans R Soc Lond B Biol Sci, 2009, 364(1525):1919-1931.
［3］Seidman LJ, Valera EM, Makris N, Monuteaux MC, Boriel DL, Kelkar K, et al. Dorsolateral prefrontal and anterior cingulate cortex volumetric abnormalities in adults with attention-deficit/hyperactivity disorder identified by magnetic resonance imaging［J］. Biol Psychiatry, 2006, 60(10):1071-1080.
［4］李飞, 苏林雁, 耿耀国. Barratt冲动量表用于儿童的信度和效度初步研究［J］. 中国临床心理学杂志, 2006, 14(2):115-117.
［5］Dougherty DM, Mathias CW, Marsh DM, Jagar AA. Laboratory behavioral measures of impulsivity［J］. Behav Res Methods, 2005,37(1):82-90.
［6］刘军, 朱炎, 伍玉枝, 苏林雁. 对立违抗性障碍儿童的脑功能磁共振成像特点［J］. 中南大学学报（医学版）, 2008, 33(7):571-575.
［7］庞高峰, 王苏弘, 马岭, 刘冬柏，陈杰，任艳玲，等. 正常儿童与成人反应抑制功能的fMRI比较研究［J］. 中国医学影像学杂志, 2009，17(1):1-4.
［8］Claes L, Vertommen H, Braspenning N. Psychometric properties of the Dickman Impulsivity Inventory［J］. Pers Individ Dif, 2000, 29(1):27-35.
［9］Horn NR, Dolan M, Elliott R, Deakin JF, Woodruff PW. Response inhibition and impulsivity: an fMRI study［J］. Neuropsychologia, 2003, 41(14):1959-1966.
［10］Bush G, Frazier JA, Rauch SL, Seidman LJ, Whalen PJ, Jenike MA. Anterior cingulate cortex dysfunction in attention-deficit/hyperactivity disorder revealed by fMRI and the Counting Stroop［J］. Biol Psychiatry, 1999, 45(12):1542-1552.
［11］刘登堂, 徐一峰, 凌政, 刘含秋，姚振宇，江开达. 首发精神分裂症患者倒背数字作业的fMRI研究［J］. 上海精神医学, 2004, 16(5):258-262.
［12］伍建林, 何立岩, 张清, 宋清伟. 汉字与英文字形辨认的脑功能磁共振成像初步研究［J］. 中国临床医学影像杂志, 2004, 15(4):181-184.
［13］Cant JS, Goodale MA. Attention to form or surface properties modulates different regions of human occipitotemporal cortex［J］. Cereb Cortex, 2007, 17(3):713-731.
［14］Vaidya CJ, Austin G, Kirkorian G, Ridlehuber HW, Desmond JE, Glover GH, et al. Selective effects of methylphenidate in attention deficit hyperactivity disorder: a functional magnetic resonance study［J］. Proc Natl Acad Sci, 1998, 95(24):14494-14499.
［15］Rubia K, Overmeyer S, Taylor E, Brammer M, Williams SC, Simmons A, et al. Hypofrontality in attention deficit hyperactivity disorder during higher-order motor control: a study with functional MRI［J］. Am J Psychiatry, 1999, 156(6):891-896.
［16］Tamm L, Menon V, Reiss AL. Parietal attentional system aberrations during target detection in adolescents with attention deficit hyperactivity disorder: event-related fMRI evidence［J］.Am J Psychiatry, 2006, 163(6):1033-1043.